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NPI Code Detail

MEDICARE: MARY RUNYAN

MEDICARE:   MARY  RUNYAN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1171100000XAcupuncturistAP 1394FL

General Provider Information

NPI Number : 1548333263
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY RUNYAN
Provider Business Mailing Address
First Line : 4253 COVERED CREEK CT
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32277-1444
Country : US
Telephone Number : 904-745-3934
Fax Number : 904-745-3234
Provider Business Practice Location Address
First Line : 1309 SAINT JOHNS BLUFF RD N STE 101 BLDG B
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32225-8396
Country : US
Telephone Number : 904-745-1735
Fax Number : 904-745-3234
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/17/2006
Last Update Date : 07/08/2007

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Directions to “ MARY RUNYAN ” Practice Location

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